$308 Wednesday, November 9, 2005 Poster Abstracts

Gortlfi, SP ~, Satyanarayana, S a, Batra, A 3, Singh, K K 4, Bhattacharya S 4, Tripathi, RP 3, Johri, S a. 1Command Hospital (SC) arid Armed Forces Medical College Pane, India; 2A rmed Forces Medical College, Pane, India; 3Institute of Nuclear Medicine andAllied Sciences; 4Army Hospital Research arid .Referral, New Delhi

Background: To study the 'Trends" in Neuro-AIDS in Indian subcontinent. Methods: One hundred thirty two patients of Neuro-AIDS profiled. 37, cases were correlated with needle necropsy diagnosis, 45 case correlated with CD4 counts and 32 cases correlated with MRI and MRS brain. Results: CNS opportunistic infections accounted for 72% cases (CNS tuberculosis-55 cases, Cryptococcal meningitis-29 cases, Cerebral Toxoplasmosis-7 cases, and Disseminated Candidiasis-2 cases), Peripheral neuropathy-13 cases (9.8"/o), and HIV dementia-9 cases (7%) are other major contributors. PML, CNS Lymphoma accounted for two cases each, Where as myelopathy is encountered in 5 cases and myasthenia gravis in one case. Needle necropsy provided proof of mixed and polymicrobial infections in 14 cases out of 37 cases. CD 4 counts suggest that meningo encephalitis is encountered as the CD4 count starts falling below 300 and unlike in western literature peripheral neuropathy is seen over a wide range of count between 0-500. Poly radicular herpes zoster is the first manifestation of im_munosuppressive state and manifested around a CD4 count of 500 mm 3. Clinico-Radiological correlation with MRS characterized different peaks for opportunistic infections, and other syndromes. Median survival observed in 55 cases is 90 days. Conclusion: Neuro AIDS pursues a stomty course in Indian subconti- nent and virtually other manifestations like CNS lymphoma and PML are very rare. HIV dementia and Peripheral neuropathy are encountered in a small percentage of cases. Polymicrobial and mixed infections deserve special consideration in management. MRS can be used to further characterize various Neuro-AIDS syndromes.

0815 Bedside evaluation of Early Neurops3:chologieal Abnormalities in patients with HIV infection

Gorthi SP ~, Shankar S 2, Gupta A ~, Johri S 4, Tripathi S 5. 1Command Hospital (SC) arid Armed Forces Medical College, Pane, Delhi; ZDepar tment of Immunology, A ll India Institute of Medical Sciences, Delhi; 3Defence Institute of Psychological Research, Delhi; 4Department of Medicine, Armed Forces Medical College, Pane; 5Institute of Nuclear Medicine and Allied Sciences, New Delhi

Background: Neuropsychological abnormalities are common in patients with HIV infection and have been shown to affect between 25 to 65% of HIV positive individuals. Early detection of these abnormalities help in individual therapeutic and occupational options. Methods: The design was a cross sectional analysis of 44 male patients infected with HIV with an AIDS defining diagnosis or low CD4 count (< 350). Digit symbol test and Trail test B were done in all patients and their value as a bedside screening test was evaluated. The tests were also done in 40 controls. The modified HIV Dementia Scale was used as the standard against which the screening tests were evaluated. Results: 63% of the patients were detected to have neuropsychological abnormality as evaluated by modified HIV Dementia Scale (m-HDS). Both Digit symbol test and trail test B were found to be effective screening tools in detecting neuropsychological abnormality and had a sensitivity of over 70?,';. The sensitivity could be increased to 90?,'; if one took the cut off point in m HDS score as 6 instead of 7.5 as recommended (Digit symbol test- Sensitivity 91%, Trail test B Sensitivity 86?,';). Combination of both tests increased the sensitivity to 93%. Conclusions: Digit symbol test and Trail test B are simple bedside tests, wlffch together take less than 4 minutes to adnffnister. Titus they can

be very effective tools in a busy HIV clinic for screening patients with early dementia. An abnormal test can be followed up by a detailed neu ropsychological evaluation.

0816 Distribution of JC virus Early Region DNA Sequences in Systemic Tissues and Brains of Individuals without Progressive Multifoeal Leukoencephalopethy or Immunodefidency

Greenlee JE L3, O'Neill FJ 2'4, Clawson SA 2"3, Carney H 2 1Neurology and," Z Research Services, Veterans Affairs Medical Center, Salt Lake City, Utah, USA; 3Departments of Neurology and," 4Ontological Sciences, University of Utah School of Medicine, Salt Lake City, Utah, USA

Background: JC virus (JCV) is a ubiquitous, usually nonpathogenic polyomavirus which is kitowlt to persist asymptomatically in kidneys. In AIDS and other inmmnocompromised patients, however, JCV can cause the demyelinating infection, progressive multifocal leukoence- phalopathy (PML), accounting for death in 4% of AIDS patients. Recently, three cases of PML have also been reported in individuals receiving the leukocyte adhesion molecule inlffbitor, natalizumab. PML has been suggested to arise following viremic spread of JCV during reactivated systemic infection. However, it is also possible that the disorder rnight arise following reactivation of persistent JCV infection within the CNS itself. To address this question, we analyzed systernic organs and brains of immunologic.ally normal individuals for evidence of persistent JCV infection. Methods: Systemic tissues and brains of autopsied individuals without PML, HIV infection, or other inmmnocompromised states were investigated for JCV early region D N A by polymerase chain reaction methods, using the primers JEP1 (CCT GTG TGT CTG CAC CAG A G G C) and JEP2 (GGC CAG TTG CTG ACT TI 'G CAGC), followed by Southern blot analysis. Results: JCV was detected in kidneys from 50% (122/45) of patients, as well as in livers, lungs, spleens, bladders, and prostates. Importantly, JCV sequences were detected in 44% (17/16) of cerebrums and 50% (16/12) of cerebellums. Conelnsion: Our data provides evidence that JCV persists in multiple tissues. Persistence witlffn the CNS is common, however, and could potentially represent the site of irdtial viral reactivation during development of PML.

0817 Detection of Herpes Simplex Virus (HSV) by Polymerase Chain Reaction (PCR) in the saliva of patients with Bell's palsy

Harirdlian, M H 1, Sarrafnegad, A 2. 1Tehran University Of Medical Science, Iranian Center Of Neurological Research, .[ran; :Department of Health, School of Medicine, Tehran University of Medical Science, Ivan

Background: Acute idiopathic peripheral facial paresis (Bell's palsy) is the most common disorder of the facial nerve. It is important because there may be significant morbidity due to incomplete recovery of severe cases. Many studies have attempted to identify an infectious etiology for this disease. Although the cause remains unkitown, recent evidences suggest a possible association with Herpes Simplex Virus-1 (HSV1) infection. Method: In tiffs case-control study we investigated the presence of DNA of HSV in the saliva of 26 patients with Bell's palsy by Polymerase Chain Reaction (PCR) method. Samples were obtained in first and second weeks of disorder. It has been compared to samples of 26 normal populations who were matched according to age, sex, and history of diabetes mellitus, hypertension, and labial herpes. Results: In the case group 3 and 7 patients had positive PCR for HSV in first and second week respectively compared to 4 in controls. Two and 6 of positive results in 1 st and 2 ~d week were of patients with severe (grade 4-6) Bell's palsy.

Poster Abstracts Wednesday, November 9, 2005 $309

Conclusion: Although the positive results were more in 2 l'a week and more in severe palsies, but a significant relationship between Bell's palsy or its severity and positive PCR for HSV was not detected (P value > 0.05).

0818 Tuberculous mastoiditis associated with facial paralysis in kidney retransplant

Hernandez Fustes, O ~, Mouchaileh, G L~, Rodrigues, p3, Ziger, F 2, Macarirfi, L 1"2. llnNeuro, Hospital Pilaf, UTP," 2Hospital Univ Cajuru," 3PUC-P.R

The mastoiditis is a complication of the medium otifis characterized by supuration and destruction of the mastoides cells and the pyramid petrosa; its tuberculous etiology decreasing in the last 40 years. The coming paralysis of tiffs is more common in children. Its incidence rises in; even so, there are not in the literature reports associated to it renal transplants. We told the a patient's case in the 71st day of renal retransplant of living donor related, in immunosuppressive therapy use that developed paralysis of the 7th cranial nerve associated with tuberculous mastoiditis.

The mastoiditis diagnosis is clinical-radiologic, being the axial tomography the election exam. The paralysis of the facial nerve happens for the easy destruction of the bony capsule that involves it. The treatment when done precoceous with chemotherapy avoids the surgical procedure. With that should stand back the tuberculous etiology in a mastoiditis, especially in immunocompromised patient.

0819 Tile role of SPECT with I23I-IMP in tile diagnosis of Creutzti~ldt-Jakob Disease

Ishida, S, Sugino, M, Hosokawa, T, Satoh, T, Fujimura, C, Nakajima, H, Furutama, D, Kirnura, F, Hanafusa, T. First Department Of Internal Medicine, Osaka Medical College

Baekgrouml: Although the diagnosis of Creutzfeldt-Jacob disease (CJD) is straightforward in fully developed cases, a definitive diagnosis can be difficult early in the course of the illness. Methods: We performed brain snigle-photon emission tomography (SPECT) using N-isopropyl-p-[l23I] iodoamphetanffne (IMP) as a tracer in the early stage of seven patients with CJD, and evaluate the clinical usefulness of SPECT in relation to the clinical symptoms and MRI findings of CJD. Results: Two patterns of the distribution of regional cerebral blood flow (rCBF) on SPECT were observed; the first, a reduced uptake of the tracer in the cerebral cortex, sometimes in an asymmetric pattern, and preserved in the thalanms, basal ganglia and cerebellum (Group A), the second, a severely decreased uptake throughout the brain, including the thalamus, basal ganglia and cerebellum (Group B). Clinical symptoms were mild including cerebellar atmxia in all patients of group B, whereas many of group A patients were bedridden state. In patients of group B, there was small area of abnomml signal intensities on diffusion-weighted M R images. The cause of these discrepant findings between SPECT and diffusion-weighted MRI in patients of group B was speculated that dysfunction of the thalamo-cortical projection systems by the thalamic lesions might result in reduced rCBF developed diffuse brain hypoperfusion. Conclusion: The two hypoperfusion patterns in SPECT imaging were observed in early phase of CJD. Each finding showed different clinical picture and might reflect the varied expanse of pathology of CJD. These findings suggest that brain SPECT provide useful information in considering the disease mechanism of CJD.

0820 Coinparafive pathogenesis of reeoinbinant rabies vacdne strain SAD-L16 and SAD-D29 with replacement of Arg333 in the glycoprotein after peripheral inoculation of neonatal mice

Jackson, AC, Rasalingam, P, Weli, SC. Queen's University, Kingston, Ontario, Canada

Background: Rabies virus causes an acute encephalomyelitis in humans and alffmals. The mouse model is an important tool in understanding the pathogenesis of rabies. Method: A comparative study was performed in two-day-old ICR mice inoculated in a hindlimb thigh muscle with recombinant rabies virus vaccine strain SAD-LI6 (L16) or SAD-D29 (D29), which contains an attenuating substitution of Arg333 in the glycoprotein. Histopatholo- gical and inmmnolffstochemical analyses of brains were performed at early daily time points and in moribund ammals. Results: Both viruses caused progressive limb weakness; mortality with LI6 was 100% at day 7 post-inoculation (p.i.) and 75% at 17 days p.i. for D29 and Kaplan-Meyer survival curves were significantly different. L16 spread to the brain more quickly than D29, and both viruses produced multifocal lesions in the brainstem tegmentum and cerebellum (deep cerebellar nuclei and internal granular layer) associated with inflammatory changes and neuronal apoptosis. There was more disseminated involvement of the brain and many more infected neurons in LI6 infection, particularly in the neostriatum, hippocampus, and cerebral cortex. In light of the lower burden of infection and smaller number of neurons infected with D29, tiffs less virulent virus was a stronger inducer of neuronal apoptosis than the more virulent LI6. Conclusion: These findings support previous in vitro studies indicating that there is an inverse relationship between pathogenicity and apoptosis. Induction of apoptosis, wlffch is an innate mechalffsm by which the host restricts viral spread, may contribute to severe clinical neurological disease when there is viral invasion into the CNS.

0821 Experience with Subacute Sderosing Panencephalifis (SSPE) in The Child Development and Neurology Unit of Dhaka Shishu (Children's) Hospital, Bangladesh

Jahan A, Azam MM, Majumdar S, Banu SH, Khan NZ. Dhaka Shishu (Children's) Hospital, Dhaka, Bangladesh

Background: Successful vaccination progranm~e brought dramatic changes in under five childhood mortality in Bangladesh, a developing country. Vaccination coverage for DPT and Polio is over 85%. For measles vaccination it is only about 77?,';. For the last few years neurology unit o f Dhaka children's hospital is fighting with the dreadful untreatable chronic illness of measles virus encephalitis, SSPE. We are just the helpless observer of its pathetic ending. Method: This is a prospective case study of the children with SSPE got admitted in our department from July 2002 till date. Results: Total 21 children were admitted with SSPE. The male:female ratio was 3.2:1. The age range was 1 yr 11 months to 13 yrs. The mean age was 6.9 yrs. Mean duration of the illness was 3.6 months. Most of them were presented in the third stage of the disease. 19 (90.1"/o) developed the illness acutely. 16 (176%) of children suffered from the illness despite vaccination at the fight time. CSF measles antibody titre for IgM was found high in 15 (171%) o f the cases. Characteristic. EEG finding was present in 9 (42.3%) of clffldren. Outcome was grave in every case. Conclusions: SSPE can occur after vaccination. But prevalence is much low. We are worried whether vaccination failure, because of incorrect preparation or preservation or other factors cause the disease in Bangladesh. This should immediately be sorted out, but it is difficult for our country. World wide research is needed to halt or to cure tiffs dreadful illness, the outcome of which is always fatal.

0822 Cllll[Cal spe~truiil~ pitfllUs in diagnosis and therapeutic implications in Herpes Simplex encephalitis